during healing. The condition is self-limiting, although antibiotics may be prescribed
in some cases. Staphylococcal organisms can cause osteomyelitis of the jaws in
children. Although the introduction of antibiotics has reduced the incidence of severe
forms of the condition, it can still be devastating. In addition to aggressive antibiotic
therapy, surgical intervention is required to remove bony sequestrae.
STREPTOCOCCAL INFECTION
Streptococcal infections in childhood vary from a mucopurulent nasal discharge to
tonsillitis, pharyngitis, and gingivitis. Scarlet fever is a β-haemolytic streptococcal
infection consisting of a skin rash with maculopapular lesions of the oral mucosa. It is
associated with tonsillitis and pharyngitis. The tongue shows characteristic changes
from a strawberry appearance in the early stages to a raspberry-like form in the later
stages.
CONGENITAL SYPHILIS
Congenital syphilis is transmitted from an infected mother to the fetus. Oral mucosal
changes such as rhagades, which is a pattern of scarring at the angle of the mouth,
may occur. In addition, this disease may cause characteristic dental changes in the
permanent dentition. These include Hutchinson's incisors (the teeth taper towards the
incisal edge rather than the cervical margin) and mulberry molars (globular masses of
enamel over the occlusal surface).
TUBERCULOSIS
Tuberculous lesions of the oral cavity are rare; however, tuberculous lymphadenitis
affecting submandibular and cervical lymph nodes is occasionally seen. These present
as tender enlarged nodes, which may progress to abscess formation with discharge
through the skin. Surgical removal of infected glands produces a much neater scar
than that caused by spontaneous rupture through the skin if the disease is allowed to
progress.
CAT-SCRATCH DISEASE
This is a self-limiting disease which presents as an enlargement of regional lymph
nodes. The nodes are painful and enlargement occurs up to 3 weeks following a cat
scratch. The nodes become suppurative and may perforate the skin. Treatment often
involves incision and drainage.
Fungal infections
CANDIDA
Neonatal acute candidiasis (thrush) contracted during birth is not uncommon.
Likewise young children may develop the condition when resistance is lowered or
after antibiotic therapy (1000HFig. 15.2). Easily removed white patches on an erythematous
or bleeding base are found. Treatment with nystatin or miconazole is effective (those
under 2 years of age should receive 2.5 ml of a miconazole gel (25 mg/ml) twice
daily; 5 ml twice daily is prescribed for those under 6 years of age, and 5 ml four
times a day for those over 6 years of age).
Actinomycosis
Actinomycosis can occur in children. It may follow intraoral trauma including dental